Job market short term and long term?

Discussion in 'Radiation Oncology' started by PhotonProton, Jan 6, 2019.

  1. oldking

    oldking Senior Member
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    Definitely worth a read but it's still so tough to really get a good sense since only 1/3rd or so responded and it's not broken down by region, which is probably the most important factor with regards to jobs in our field. The distinction between "academic" and "private" has definitely changed over the past decade or so and appears to be increasingly blurry plus a lot can change between 2012-2017 vs 2025-2030 or whenever current medical students thinking about pursuing a career in radiation oncology would be entering the workforce (and of course I'm sure they care about further opportunities throughout their subsequent 25-35 year career). In any event l this paper provides a lot of valuable information and it is wonderful that this gentleman continues to put forth the effort to gather this information for no apparent reason other than as a service to our field and trainees.
     
    #51 oldking, Jan 11, 2019
    Last edited: Jan 11, 2019
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  2. Neuronix

    Neuronix Total nerd
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    As someone who paid attention to this data as a resident, I always looked forward to receiving this survey and completing it when I graduated a few years ago. I never received one.

    Terry Wall is awesome though. His lectures about the evils of non-compete agreements are also excellent.
     
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  3. Neuronix

    Neuronix Total nerd
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    There are a number of people out there in the real world discussing SDN right now. They are trying to portray that a minority of the rad onc community is hiding behind anonymity and using SDN to be vocal about a problem that doesn't exist in the real world.

    What about off of SDN? ASTRO's ROHub (online non-anonymous community) has a thread on this topic titled "Are we over training the number of Radiation Oncologists?"

    See: https://rohub.astro.org/communities/community-home/digestviewer/viewthread?GroupId=1561&MessageKey=458c4ffe-ba2d-4641-b8ea-c957da0752ca&CommunityKey=881f9cc8-10ec-45b6-ad5f-5ff678d86fdd&tab=digestviewer&ReturnUrl=/communities/community-home/digestviewer?communitykey=881f9cc8-10ec-45b6-ad5f-5ff678d86fdd&tab=digestviewer

    For those of you who don't have access since it's a closed community, the discussion is a rehashing of exactly what we are writing on SDN. The thread starts by proposing the question and referencing the several journal articles on this topic (I will reference these on request). The ensuing discussion on ROHub should look very familiar to those of you who follow this issue on SDN.

    1. A well known professor of rad onc posts that the number of residency positions should be reduced. They post that residents are often being substituted for more expensive midlevels and other support staff. In their opinion this has been a problem since the 1990s.

    Other responses?
    2. Small programs should discontinue their training programs.
    3. Unclear that the real world is as bad as the "internet echo chamber" and also "general expectations" (I assume this means that the job market expectations of grads is too high?).
    4. The residency review committee has no power to evaluate residency expansion or the job market due to fears about anti-trust allegations.
     
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  4. RickyScott

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    Is there anything to the effect of hypofractionation/bundling or the more selective use of XRT impacting the future needs?
     
  5. Neuronix

    Neuronix Total nerd
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    No. I'd encourage you to post. I do feel that I need to maintain my anonymity for professional purposes.
     
  6. RickyScott

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    Sounds like a very informed discussion. If there is no acknowledgement of 1) residency expansion- doubling of resident numbers over 15 year period and 2) changes in practice patterns.. hypofractionation), it kind of reinforces that astro is a problem. Any alternative facts?
     
    #56 RickyScott, Jan 17, 2019
    Last edited: Jan 17, 2019
  7. OTN

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    It won't let me into the discussion, can anyone post here?
     
  8. Mandelin Rain

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    I love my job. I love my patients. I love my pay, and my lifestyle, and my vacation, and location, and....

    I am very positive about my current situation. I am. Like dream scenario positive.

    But, math. That's the issue here. Black and white math. It's hard to paint math as overly negative or positive. Math does not exist only in an echo chamber.

    Residents double. Number of treatments per diagnosis halve. This is problematic math. Even in my bubble of personal positivity, I can't see it ending well.
     
  9. Mandelin Rain

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    The issue will likely come to a head at the start of the next true bear market. Like market 30-40% correction. All the normal attrition of retiring docs is disrupted. Hiring practices tighten their belts. There will be a problem for that graduating class.
     
  10. RickyScott

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    exactly same here.
     
  11. Neuronix

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    I think that's a bit unfair. First, the discussion has only been going for 3 days and has a limited number of posts.

    Additionally, "ASTRO is a problem" is a bit silly when it comes to their forum. There are many members who can post there and give their thoughts, and what is posted doesn't necessarily directly reflect ASTRO's views. It's like writing that "SDN is a problem" just because the opinions expressed aren't concordant with your views.
     
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  12. GapCalc

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    One of the downsides of our small field is that it’s very difficult to speak out because you could face repercussions. The ROHub thing is a gimmick — they just want to compete with the MedNet (treatment discussion) and issues surrounding the job (SDN). I personally don’t think there is room for authentic discussion there because the hard questions will seem “aggressive” to the Powers That Be. And with the increasing scramble for good academic jobs, can you really gamble your future by questioning ongoing expansion?

    My program is expanding. When asked about the job market and general oversupply, the department leadership essentially says “not my problem.” The applicants will figure it out, apparently. And these people are heavily involved in ASTRO. If the ASTRO cheerleaders can’t address oversaturaion within their own programs, how can we trust that they will answer the question on a bigger scale? Short answer: we can’t.
     
  13. OTN

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    I cannot understand how a radiation oncologist can be so callous and uncaring regarding the careers and lives of those who choose to follow in their path.
     
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  14. shepardsun

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    "It is difficult to get a man to understand something when his salary depends on his not understanding it."
    - Upton Sinclair
     
  15. Sheldor

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    Isn't this the opposite of this though? Their salary depends on them understanding it :)
     
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  16. oldking

    oldking Senior Member
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    In training I always heard about the super greedy, money hungry private practice guys (and I’ve met more than a few), but man a lot of these older academic guys are the most lazy and selfish people on earth. They couldn’t care less if the field goes to hell in 5-10 years (after they are retired) as long as their service is covered by a million residents today!

    Those who are expanding residency spots and destroying the field are not the ones who will be affected by their actions.
     
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  17. medgator

    medgator Senior Member
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    Two sides to every coin. The shady pp guy giving too many fractions to breast and bone mets is matched by the ASTRO academician blessing unnecessary residency expansion, questionable proton registries for prostate CA and arguing against site neutral payments, while telling the rest of us to "Choose Wisely"

    There are bad actors in both spheres
     
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    #67 medgator, Jan 18, 2019
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  18. oldking

    oldking Senior Member
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    And the remaining 50-95% of us in the middle doing the right thing and loving our jobs and lives but helplessly watching it go to hell for the next generation ...
     
  19. Reaganite

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    I do consulting work for insurance companies, and we've seen cases where it's actually cheaper to have the local PP guy do IMRT for a bone met than have the local academic center "choose wisely." The rate discordance in some cases is shocking.
     
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  20. KHE88

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    Great post, and I agree with you. I have noticed a lot of peculiar comments from med students and residents about SDN. It's almost like dissing SDN is a way to signal that you are somehow more enlightened than those that post here and that being involved in online discussions on SDN is somehow shameful and embarrassing. I have noticed very bold claims from residents that the "job market is fine" despite self-admitted difficulty in finding good jobs in specific locations and difficulty with contract negotiations (bad take-it-or-leave it contracts). Perhaps they just have low expectations? Med students interviewing have claimed that "everybody I have met where I interviewed said they had no problems finding jobs," "there were tons of jobs in new york and SF this year," etc.

    Why are so many of our peers sticking their heads in the sand about this? Why cannot we have an open and honest discussion? Is our field really so nasty that we would professionally assassinate someone if it was revealed they posted on SDN? They refer to this place as the "echo chamber" as you say despite hundreds of different active users here. The Radbio thread has over 100,000 views. It is popular to feign ignorance about SDN. I hear it all the time. The job market comes up and somebody has to chime in and say "Oh the job market is fine, you must have been reading that online. What's that website, SND? MDS? Some medical student forum? Anyway, something like that. Yeah those people are insane/crazy/extreme - the real world is not like that at all." Give me a break.

    We have seen this place referenced in the literature before with drive-by punches like "echo chamber" and the credibility of what is posted attacked simply because it is posted and where it is posted ad-hominem style with no objective evidence or logical refuting argument. In national meetings, prominent figureheads have claimed they were cyber-bullied on SDN in order to discredit valid concerns and criticisms and avoid admitting fault while curiously turning around and bullying their audience into silence and submission.

    Here's a great recent example from our friends at ASTRO's ARRO: ARROgram - American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

    "Take any negativity about the field and the discussions on internet forums with a grain of salt. Radiation oncology is an amazing specialty and there are many opportunities to succeed. Ask targeted questions and you will find that most radiation oncologists very much love what they do."

    "Speak with physicians and residents in the field: Most information on the internet is from a handful of individuals. Make sure to talk to residents and attendings in-person or by email in order to get the real story."

    Really? A handful of individuals? The above quoted text was literally written by two residents. There are hundreds of practicing attendings who read and post here, admittedly some more than others. I think we do our field a real disservice when we cannot openly talk about the job market, salaries, training issues, and for some perverted reason feel like we need to disavow all knowledge that SDN exists, pretend not to know about it, and have to make bold proclamations in person that we disagree with any opinion posted online lest someone think we are one of the nutjobs that posts here. Although I suppose I am the one feigning ignorance about not knowing why we don't speak up. We have seen what has happened when people have gone against the grain in the literature and at national meetings.

    I am reminded of this:
    Cheesy, but makes you think. "Americans have an enormous taboo about money. But all that taboo does is take power away from the employee and give it to the company." Similarly, rad oncs seem to have a taboo about freely discussing problems online. And what does that taboo do? Where is the power in our field? Who has the voice?
     
  21. thecarbonionangle

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    The poster with the echochamber comments on there should be absolutely embarassed for her nonsensical comments. Great example of our “leaders”.
     
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  22. radiation

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    Most of the discussion here about the long term health of the specialty has been focused on the adjusting the number of graduates and preventing oversupply. Given the current job climate I think its a reasonable discussion and should certainly be addressed by leadership. However, in terms of long term effect on the field, I believe the most important thing we (and the leadership of the field) can do is to expand the use of radiation. Radiation is underused in almost all disease sites and stages of disease. Take a look at the NCDB data for the use of radiation in stage IV disease
    http://oliver.facs.org/BMPub/BMR_re...41fbbd0a3-104FA76D-E6DA-9A62-B1B91C7CC79639F2
    upload_2019-1-19_15-47-57.png

    I acknowledge NCDB has all sorts of caveats but I think its reasonable to ballpark that the number of stage IV pts getting XRT is much lower than probably what it should be. I don't know what the appropriate number is, but I would estimate that at least half of pts with metastatic disease would be benefit from palliative radiation at some point (not to mention the emerging oligomet population).

    So if we are going to ask our leadership to put resources into the supply problem, we certainly should be looking into putting more resources into the demand side. That means doing a better job about advocating for the field - not only increasing the indications for radiation, but actually applying those approved indications in the community at a higher rate. Not to mention pushing for things like increasing lung cancer screening etc that would increase the SBRT pool. We also have not advocated nearly enough to keep the radioisotope domain within our field.

    The Ben Smith paper estimated there would be an increase of 19% in demand and 27% increase in FTEs from 2015-2025. Whats better for the field long term, decreasing residents by 8% or increasing demand by 8%? To me there is plenty of room to move the needle on demand, and the long term survival of the specialty would be better served having more high quality, intelligent physicians in our field and increasing underutilized demand. Hypofrac may end up paying less but I actually think long term will increase the absolute number of patients getting treated as radiation becomes more convenient. I am not sure keeping our specialty small will do anything to combat the perpetual issues we have being marginalized by larger departments. A smaller specialty also means weaker negotiating power with insurance companies and a smaller government lobbying force
     
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  23. RickyScott

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    Exactly. The problem is now the financial excess is hidden. Historically, when utilization more directly reflected costs, it was obvious when a doc was running up the bill with over treatment. The mantle of financial abuse in this field was long ago passed from the 21Cs to the large regional/academic health systems and their out of control pricing.
     
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  24. evilbooyaa

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    Some people with established careers in academics are unknowing about the nationwide job market and/or unwilling to accept a poorly functioning job market?

    Color me shocked.

    The fact that the RRC is willing to punt responsibility and ASTRO has not deemed this to be an issue worth talking about and coming up with any solutions to is the main disappointing bit.
    Relying on chairmen and chairwomen to self-regulate when residents improve the departmental bottom line and improve their yearly bonuses is a laughable solution.
    Just like the solution that eventually, this field will become so non-competitive that medical students won't apply and won't match into the bloated pool of residency slots.
     
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  25. medgator

    medgator Senior Member
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    I just don't understand why RO academic leadership was willing to address this in the 90s, but now they are acting like ostriches with their collective heads in the sand.

    Even if we remain static in xrt indications and fractionation, we still wouldn't justify increasing spots by 50% in the last decade
     
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    #75 medgator, Jan 21, 2019
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  26. RickyScott

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    could someone post the thread from ro hub. I am generally curious how this is addressed.
     
  27. Neuronix

    Neuronix Total nerd
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    The compromise in the 90s was to extend residency by one year. That way the number of residents graduating dropped while the number of residents in a given program was the same.

    Would we be willing to expand rad onc an extra year now? Programs seem like they would be ok with it (just like fellowships). Still, I think we're well enough trained in four years. Further, adding a year now would still not sufficiently correct the supply of residents. Also, when programs start expanding again, we'll be right back where we started.
     
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  28. medgator

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    I was under the impression several programs reduced spots and a few actually closed. Obviously happened before my time, maybe old king or someone else who was around then could chime in
     
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  29. evilbooyaa

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    I thought they radically changed educational requirements back in the '90s to include more oncological education.... only thing that's going to give us something similar now is a stark change to educational requirements, especially to things that are especially low-volume throughout many residency programs (interstitial, pediatrics, etc.).
     
  30. seper

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    I’ve been a RadOnc generalist for just short of 10 years, and would say that if 20-30% stage IV patients get local RT, that would about right use of this modality.




    Sent from my iPhone using SDN
     
  31. bachiraki

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  32. oldking

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    It was before my time as well (believe it or not the early 1990's were 25 to almost 30 years ago!) but I don't think the leadership is the same now as it was back then but in any event I'd argue that what really "saved" our field if not propelled it through the roof (almost literally . . . we went from forgotten weirdos in the basement to the top of the agenda of senior administrators and suddenly invited to high level, hospital/university/cancer center wide planning meetings, etc) was the development of IMRT and the increased indications for RT plus huge technical $$$ it brought in (and later to a lesser extent SBRT/SRS) . . . I don't see anything like that ever happening again or at least any time soon.
     
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  33. Mandelin Rain

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    Any press is good press, I guess.

    My favorite part about this was the lack of discussion about the selection biases inherent to sending out a survey like this. Of course you'll get more positive, than negative responses.

    "Anecdotal stories posted on online community sites, potentially representing a minority viewpoint, have placed radiation oncology in the spotlight with respect to future employment concerns."

    Umm, the response rates to the survey cited in the study varied between 14-41% depending on group queried. Your paper is literally and demonstrably representing a minority view point.
     
    #83 Mandelin Rain, Jan 22, 2019
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  34. evilbooyaa

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    Don't get access to JACR, but funny how the abstract has zero notes about medical students or current residents. The fact that 20% of new grads aren't even moderately satisfied of a sample affected by selection bias should be concerning...
     
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  35. fiji128

    fiji128 Junior Member
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    I kinda of doubt that one could conclude this data is reflective of anything when the response rate is so low and all the inherent biases that could go along with that.
     
  36. RickyScott

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    Even if the job market were wonderful today, the overarching concern remains that doubling of resident numbers (in the article they say 50%, but this is just choosing dates to minimize the percentage, from circa 2005 it is about doubling and changes in utilization will have a big impact in a 5-10 year time frame. The outlook is the real issue here, and one that these people are just loathe to address.

    Like sea level rise, surveys that say water levels are ok today,dont address everyone's concern, which is the future. Weather was really cold today, does that mean global warming is not happening.
     
    #86 RickyScott, Jan 22, 2019
    Last edited: Jan 23, 2019
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  37. medgator

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    Or the sustainability of Medicare, ss etc. But it seems to be the boomer philosophy these days of getting theirs, everyone else be damned. RO academia is no exception
     
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  38. Mandelin Rain

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    So very much like every day of the boomer generation since conception?
     
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  39. oldking

    oldking Senior Member
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    This is the most horrifying:

    Question: Your program is looking to expand the residency program.

    Response from Chairs: 11.8% strongly disagree, 5.9 % somewhat disagree, and 5.9% disagree

    I didn't look to carefully at response rates but at least according to this sample only 1 in 4 chairs seem to think there is a problem on the horizon and 3 in 4 are actively looking to expand their residency program or at best wouldn't be opposed to it?
     
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  40. sphinx2019

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    IM>>>>Nurse Anesthetist>PA>Nurse>Path~RO
     
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  41. echada

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    upload_2019-1-22_20-2-15.png

    47% of the chairs are looking to expand their residency and 41.1% of them think residents should be required to do a fellowship.

    Rad Onc is the new pathology!!!
     
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  42. sphinx2019

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    Rad onc is worse since our society is using board examination as concealed market regulation.

     
  43. KHE88

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    I'm honestly surprised the numbers aren't worse. Our chair has mentioned wanting to double residency spots and add fellows. My understanding is most think the same way. It makes them look good to their bosses.

    Thinking that the programs will self-regulate in an attempt to save our field for the next generation or the market will self-correct through medical student self-selection is idiotic. The only way to prevent us from becoming the new pathology (or likely worse at this point) is a broad collective action at the national level. Instead we have this silliness about antitrust law thrown around by non-lawyers as a cop-out to avoid the freight train of suck headed right at us probably well past the point applying the brakes does any good.
     
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  44. Old rad onc

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    I was in residency from 91-95. The change from 3 years to 4 happened in 1987. In 1995 there were 70 residents per year graduating and the job market was a little tight but plenty of jobs in the Midwest and South.

    The leadership of ASTRO were old school gents like Perez, Brady, who did not think much about using and abusing residents and junior attending. When I started residency planning was 2D and we had to use projections of CT’s and graph paper to do calcs in 3D. Everything changed by the late 90s where 3D computers and IMRT transformed Rad Onc.

    Most of the heads of departments and guys looking out for themselves are probably in their 50’s to 70 now. They are near the end and I guess don’t care but In the 1990’s most of the field was pretty cool. The people that Terry Wall described as Sharks have always existed but many residents figured it out by job history. So much has changed that it is much harder now and the true Gentleman of our field are no longer in charge. I do not believe increased utilization is much of a possibility now. But the agile, wise, and friendly Rad Oncs are not to be underestimated. It’s not over yet but a storm is coming. An accounting of all of medicine is coming not just Radiation Oncology. Even outskirts of big cities will be challenged by big academic centers. Choose wisely...... your partners large and small.
     
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  45. RadOncDoc21

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    So true! I have boomer partners and they really can not let go of a good thing!
     
  46. oldking

    oldking Senior Member
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    Thanks for the memories . . . I'm more than a few years younger but I too had the pleasure of meeting those true leaders and gentleman and watching the field transform in less than a decade. I also agree those private practice sharks have always been around but we all knew who they were (or how to figure it out) and honestly most of the people they took advantage of were other scumbags or like-minded people, not masses of hard working, top of the medical school class, but increasingly desperate new graduates.

    You guys have to realize that the changes that we are talking about that happened in the 1990's in radiation oncology changed everything in a way that simply can't and won't happen again. Do you really think that in the next 10-12 years we will have the technology explosion equivalent to going from projectors of grainy x-rays with grown men huddled on top of each other trying to mark bone anatomy with wax pencils to CT based planning and 3D treatment delivery, then IMRT with IGRT, and SBRT/SRS? Even if the RT technology somehow exploded like that again I can guarantee that payers aren't just going to provide technical fees in wheel-barrels like they did when those technologies first came out in the same way for whatever is next. We can guarantee that chairs will keep thinking that expanding residencies and having unemployed graduates complete fellowships though . . .
     
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  47. RickyScott

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    Looked at the ASTRO discussion board and to my surprise, thought it was fair, with most academic leaders acknowledging dangers of residency expansion. Here are posts by prominent docs (I left out names) for medical students who dont have access. Given the overall sentiment on the board by many former program directors and really prominent voices in this field, it is absolutely shocking ARRO would suggest that medstudents ignore concerns over job market. Total loss of credibility,


    "I have concerns about how the workforce supply will impact the quality of applicants and future trainees. Our specialty is nearing the end of it's gilded age and the high volume of physician-scientist (MD-PhD), research driven candidates with lofty board scores is starting to thin out. This is partly due to the fact that some graduating residents are challenged trying to find the best job in the best geography and partly due to the fact that our specialty simply didn't have the high level academic posts for those wanting a physician scientist career. Very few programs have a strong, robust cancer biology program with sufficient grant support and research space to keep them in academia. This is where our societies like ASTRO, ACR, RSNA, etc can help. We need to find a means to invest in the future of our specialty by expanding research opportunities. It's why the Radiation Oncology Institute (ROI) was created and why I support it!

    As those top candidates now pursue alternative specialties and careers are we going to see the quality of candidates and future residents decline? Will programs go unmatched? I doubt it. I think we will see some programs fill in the post match scramble with candidates ill prepared or motivated for a career in radiation oncology."



    "In my opinion, YES, we are training too many radiation oncologists. Many of the points have already been made so I won't restate them. Perhaps the most important point was by Dr. Chronowski (sp?) who reminded us that organizations such as AAMC, ASTRO, ACR, etc, CANNOT weigh in on this formally, as it could be interpreted as anti-trust.

    Radiation therapy is used for ~2/3 of all cancer patients, by most estimates. So with ~1.5M cases per year, one could estimate ~1M patients a year requiring RT per year. Cancer incidence is growing and, presumably, RT utilization will follow, but this may be ouweighed by the impacts of hypofractionation and the impact of AI in our field.

    Hypofractionation is becoming increasingly utilized and at some point, AI will enter our space, specifically in contouring and treatment planning. Both of these developments will significantly impact workforce requirements. I'm not as convinced that true computer-assisted decision support (CADS) will replace or even meaningfully impact our cognitive thought, but we shall see."



    "Yes. Reduce the number of residency positions. Frequently the number of residency slots is driven by the need for inexpensive manpower in programs which, for the most part, depend on residents to perform tasks that could be performed by RNs, ARNPs, PAs, secretaries, and attendings. I have been on faculty since 1982 and work in two locations in a university based practice where one is resident dependent and the other is not. While it is a difficult transition to make, it can be done and is necessary for the health of our specialty. This impending problem has been apparent since the mid 1990's and could have been avoided if we had the discipline to make some difficult choices."



    "I wanted to make the point that unbridled residency expansion + decreasing number of fractions via hypofractionation/SBRT is simple math (see attached figure).

    Between 2000 - present, we have effectively doubled the number of Radiation Oncology residents. We have publications demonstrating that the Radiation Oncologist need was vastly overstated. ASTRO Choose Wisely recommends that virtually all breast cancer treatment lengths be cut in half. Prostate is coming next."


    "I say all this to emphasize that the trends are all looking bad. We can simply dismiss the warnings as tin-foiled hat rantings of a bunch of malcontents and anonymous internet trolls or we can accept the quantitative reality for what it is, sit down, come up with solutions and save our specialty."Dr. Michalski's concerns are well grounded - we are seeing a decrease in the number of applicants and, as Dr. Lee points out above, this year the number of spots offered through The Match is greater than the number of applicants (down to 190 (2019) applicants from 221 (2018), 235 (2017), 223 (2016)). These unfilled spots can be filled post-Match. We may also see an increase in non-US graduate interest as the "barrier to entry" is lowered. This may be reflected in the metrics published in the NRMP's Charting Outcomes of the Match by showing RO as "less competitive". Ultimately, this may impact the quality of the workforce (although quality can mean many different things, and ROs that give excellent patient care but are less interested in research should be valued, particularly in the setting of maldistribution)


    "- Concern regarding the future of the specialty and future employment prospects has led medical students to be actively discouraged to pursue the specialty by many current residents and practicing ROs. This may be driving the first point above.
    - Just because a program is approved for a certain number of spots by the ACGME does not mean they have to fill them. Individual action can be taken to decrease the number of spots (not collective action, which would be perceived as antitrust as above)
    - It is an oversimplification to say that decreasing number of fractions (hypofractionation/SBRT) will lead to bleak employment prospects, but yes, the average number of fractions delivered has decreased across all disease sites over the last decade, and that trend will likely continue.
    - To answer the original poster's question, "do you perceive this to be a problem" - the answer is yes – the 2017 ASTRO Workforce Study showed a majority (53%) of ROs are concerned about a future oversupply of ROs (up +20% from the 2012 survey!).
    - A final point that has not yet been raised- just as it is disingenuous increasing training minimums solely as a way to manage the workforce, so it is it disingenuous to have a rise in fellowship training secondary to supply-and-demand issues, as opposed to a true need for further specialization. This is something to monitor as the number of RO fellowships are increasing (n.b. these fellowship are not ACGME accredited)"



    "It is an oversimplification to say that programs are paid by Medicare according to the number of positions. Medicare has capped spots for more than two decades. Many programs pay for residents through professional revenue, hospital system support, philanthropy or some combination of these.
    I was on the RRC of ACGME for 6 years and chaired the committee my last three years. The ACGME is forbidden from using workforce in deciding whether programs can expand or new programs begin. There is an application process; if the patient numbers, attending physicians and facilities are sufficient than a request for increase is granted.
    In my view we are two problems: 1) overtraining (too many physicians) when market forces are reducing demand (hypofractionation, capitation) AND 2) geographic maldistribution. The first problem is more important to address.
    Unfortunately until training programs decide to limit training positions on their own, nothing will be done.
    In a related note, this is likely the first year in more than a decade that the number of training spots is GREATER than the number of US graduates applying.
    Not good for our discipline."
     
    #97 RickyScott, Jan 31, 2019
    Last edited: Jan 31, 2019
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  48. bluebubbles

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    "the warnings as tin-foiled hat rantings of a bunch of malcontents and anonymous internet trolls"

    "medical students to be actively discouraged to pursue the specialty by many current residents"

    As a semi-anonymous internet troll, I typically discourage medical students in real-life from pursuing radiation oncology, but I especially discourage the best & brightest medical students from pursuing radiation oncology due to the concerns outlined in the ASTRO discussion board.
     
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  49. MegaVoltagePhoton

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    Am I allowed to note that irony of that particular ASTRO board discussion person attacking SDN?
     
  50. Neuronix

    Neuronix Total nerd
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    I'm not sure where this discussion is going but... Absolutely no linking of real identities (e.g. ASTRO forum) to SDN identities which are supposed to be anonymous. No speculating about real vs. SDN identities either.
     
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